The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Sunday, November 22, 2009

Reports critical of major British public hospital over child abuse

Whistleblower fired rather than heeded. "Rocking the boat" is the one unforgiveable sin in a bureaucracy. Too bad about the patients

Great Ormond Street Hospital failed to answer senior doctors’ justified concerns about the clinic which failed Baby P [who died of abuse from his carers], according to two secret reports. The hospital provided the doctors at the Haringey child protection clinic where Baby P was a patient, and was the “lead agency” for child abuse, running the clinic with Haringey Primary Care Trust.

The reports, seen by The Daily Telegraph, say that child safety at the clinic was a matter for “grave concern” and that Great Ormond Street managers failed to act adequately on “significant problems” identified by the most senior doctors at the clinic more than a year before Baby P’s death. Instead, the “most vocal” was removed from her job, they say. There was inadequate staffing at the clinic, and “the workload of the consultant team was excessive”.

One doctor, Michelle Zalkin, told the investigators that Great Ormond Street and Haringey managers created a “very hostile environment” which became “quite unbearable”. They communicated, she claimed, largely by “shouty emails and Post-it notes”.

In April 2006, the four most senior consultants at the clinic wrote a joint letter to managers warning of the “very high risk” of a tragedy without more staff. They said their concerns had been “trivialised”. Some action was taken, the reports say, but staffing was cut further and Dr Kim Holt, the consultant identified as “the most vocal,” complained of being “targeted” by managers. She was removed from her job and remains on “special leave” on full pay. Two other consultants resigned and the fourth, Dr Sukanta Banerjee, went off sick, though she has since returned.

By the time Baby P, identified as Peter Connolly, came to the clinic in 2007, there were no experienced consultants and he was seen by a locum, Dr Sabah al-Zayyat, who missed his broken back. Two days later, the 17 month-old was found dead in his cot with broken ribs, lacerations to his head, a finger tip missing, broken teeth, and scores of bruises.

One of the reports, commissioned by NHS London, the strategic health authority, into Dr Holt’s case, finds the consultants’ concerns were “genuine and well-founded”. It is a conclusion echoed by the other report, by Prof Jo Sibert and Dr Deborah Hodes, experts in child protection, into the appointment of Dr al-Zayyat.

The NHS London report says the concerns were “taken seriously” and some action followed but there was “no evidence” that the main worry, consultants’ workload, was “adequately addressed”. The number of consultant posts was reduced after the complaints, from four to three. Since Baby P, it has been increased to nine posts.

The report says the Great Ormond Street manager responsible for the clinic, David Elliman, claimed the problems did not affect patient safety. “We would not agree,” the investigators say. They describe Dr Holt as “highly committed” and say: “We do not consider Dr Holt has been directly targeted, but we do consider that she is entitled to feel aggrieved.”

Dr Holt, who has lodged a formal grievance against Great Ormond Street, refused to comment. A hospital spokesman denied victimisation and said they were keen to resolve any issues with her amicably but could not comment further.

Australians are given to believe that they can rely on their State government for "free" medical care. "Free" does not mean "available" or "high quality", however. What it DOES mean is that what you save in money, you pay in time

THE last straw for Angela Baines came when she arrived at school 45 minutes late and found the police had been called to collect her children.

The Umina single mother of four had struggled to Royal North Shore Hospital on the train every day for five weeks for radiation therapy after breast cancer because no public facility was available locally and she could not afford private treatment. But any wait for her radiation doses or a missed transport connection could scupper her tight timetable.

"I said, 'That's it. I'm going home. I'm pulling out. I cannot endure another day of this possibly happening again,' " said the 39-year-old of her experience two years ago. Ms Baines told the hospital she was cancelling her last week of treatment, but a doctor immediately called to promise that she would be treated the moment she arrived. She completed the course and is now in good health.

Inequitable provision of radiotherapy services across NSW is resulting in serious emotional trauma to patients already vulnerable from surgery, drug treatment and a potentially life-threatening diagnosis, according to a survey released today by the Cancer Council NSW.

Its Roadblocks to Radiotherapy report collects stories of the practical, financial and psychological hardships experienced by people who have to travel long distances for radiation or miss out on the treatment - which can prevent recurrence and is recommended for at least half of cancer patients but in NSW is received by only 36 per cent.

Based on a telephone call-in earlier this year, the survey found rural and regional patients were impressed and grateful for their treatment, but were distressed by practical difficulties. "We hope showing the human element adds urgency to the need for reform," the council's manager for policy and advocacy, Anita Tang, said.

The Auditor-General concluded in a June report that NSW Health needed to intensify its long-term planning for radiotherapy services, especially in high population growth areas including the Central Coast, Hunter, New England, Illawarra and Shoalhaven areas. The department has prepared a draft Radiotherapy Services Plan 2007-11, but has never released it.

In his landmark report on NSW public hospitals a year ago, Peter Garling identified services for patients outside cities as a major problem, recommending revitalised training for doctors outside urban centres and improved travel provisions for people treated far from home.

The Opposition spokeswoman on health, Jillian Skinner, said: "Labor has failed to match radiotherapy services with population growth, with the result that many families are undergoing extreme hardship just to get access to treatment. Cancer cases are predicted to grow by 30 per cent over the next 10 years … what is Labor waiting for?"

After “many months of discussion” in which the National Federation of Independent Business was engaged in efforts to ensure that the high cost of health care was adequately addressed in reform legislation, the organization yesterday came out in full force against the Senate health care bill, declaring it a “disaster for small business:”

Small business can’t support a proposal that does not address their No. 1 problem: the unsustainable cost of healthcare. With unemployment at a 26-year high and small business owners struggling to simply keep their doors open, this kind of reform is not what we need to encourage small businesses to thrive.

We oppose the Patient Protection and Affordable Care Act due to the amount of new taxes, the creation of new mandates, and the establishment of new entitlement programs. There is no doubt all these burdens will be paid for on the backs of small business. It’s clear to us that, at the end of the day, the costs to small business more than outweigh the benefits they may have realized.

NFIB declared the Reid Bill to be unacceptable due to the “impact from these new taxes, a rich benefit package that is more costly than what they can afford today, a new government entitlement program, and a hard employer mandate” which together would cripple small businesses.

The organization’s conclusion is not surprising, given that the Reid Bill leaves small businesses in a lurch. The bill essentially acknowledges that it is terrible policy for small businesses, given that it includes a “small business tax credit” to minimize the impact of the job killing employer mandates and regulation-caused rises in private health insurance premiums.

The problem is that the tax credit only lasts two years and largely excludes small business owners, small businesses with high-average payrolls, and firms with 25 or more workers. After all exclusions, essentially the only eligible firms are those firms with 10 or fewer workers as well as those with low-income workers—the least likely to offer coverage even with a significant price reduction.

Members of the Project 21 black leadership network have risen to condemn Jesse Jackson for saying of Rep. Artur Davis (D-AL), "You can't vote against health care and call yourself a black man," calling Jackson's statement divisive and likening it to the mental tactics of a antebellum slaveowner.

Declining to respond in kind, Rep. Davis told The Hill newspaper, "The best way to honor Reverend Jackson's legacy is to decline to engage in an argument with him that begins and ends with race."

Project 21 members were less retrained. "Shame on Jesse Jackson for using the race card in an attempt to influence the views of another black politician," said Project 21 Fellow Deneen Borelli. "Ironically, Jackson is acting like a slaveowner trying to keep blacks on his ideological plantation, where they are required to support government programs that increase public dependency on a bureaucracy," Borelli added. "In Jackson's world, it appears a black man cannot have independent thought. They must follow Jackson blindly or face lashes from his tongue."

"What makes Jesse Jackson an authority on being black in America more than anyone else? Why is he able to determine how we must think?" asked Project 21 member Kevin L. Martin. "It's no mystery why Jackson consistently failed to win broad appeal for his goals and must instead resort to ugly racial politics." Martin added: "Blacks who have sought to exercise their free will are well aware of the disdain, disrespect and derision that comes with straying from the liberal plantation. Welcome to the club, Congressman Davis."

Jackson's smear was made during a Congressional Black Caucus Foundation reception held on November 18 to mark the 25th anniversary of his presidential campaign. Rep. Davis (D-AL), a black congressman, voted against the House version of Obamacare.

The editorial board of the Omaha World-Herald makes a brilliant case calling on Senator Ben Nelson to vote no on a cloture vote for Harry Reid's Health Care plan. Nelson is one of the most closely watched swing votes. This should be an argument made coast to coast on why the plan should be stopped before it can make it to the Senate floor.

From the Omaha World-Herald: Sixty votes will be needed to send Sen. Harry Reid's health care proposal to the Senate floor for debate. Sen. Ben Nelson, one of the most closely watched swing votes, should vote no. Why? Because Reid’s proposal, like that approved in the U.S. House, would place immense burdens on small and medium-sized rural hospitals in the Midlands. It would not prevent further steep increases in health care costs.

It would, however, shunt billions in new costs onto state governments. And its budget savings at the federal level depend on empty, misleading promises of fiscal discipline that Congress has shown it’s utterly incapable of fulfilling.

If anyone doubts the threat to Nebraska, especially its rural areas, remember that it was Reid himself who tried to get a side deal to hold his own state of Nevada harmless from the increased Medicaid expenses that would raise costs steeply for state governments — and thus state taxpayers.

Those considerations need to occupy the very forefront of Sen. Nelson’s thinking as he ponders how to vote on the proposal. Is he more worried about making sure that the vital interests of Nebraska are protected, or about pleasing Reid and House Speaker Nancy Pelosi?

There ought be no question about what the proper answer should be. And that answer — making absolutely sure that health care legislation does not harm the interests of Nebraska — should lead the senator to vote “no” on sending the legislation to the floor.

If the legislation does win final passage in the Senate, it then would go to a conference committee with the House. The odds are that the conference committee would make the legislation even more heavy-handed and centralized, without proper consideration for the burdens placed on Nebraska. In the Senate, the conference committee’s proposal would need only 51 votes to win final approval. Nelson at that point could vote no and the legislation nonetheless would become law with the president’s signature.

No matter how much Nelson then said, “Look, everyone, I voted against it in the end,” the real-world harm to Nebraska would be gigantic and longlasting.

The state’s smallest and most vulnerable medical facilities would face enormous pressure. Major new expenses would fall on the state government. And judging from what Congress has decided so far, the legislation would do nothing serious to curb health care inflation.

Just this week, Jeffrey S. Flier, the dean of Harvard Medical School, wrote an opinion column on the nation’s health care debate, saying, “I’d give it a failing grade.” He added: “Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that’s not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost — and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.”

If the Senate does take up the Reid proposal, Sen. Nelson’s fundamental obligation throughout the debate should be to focus on safeguarding Nebraska’s interests, particularly its rural areas. Nebraskans need to be watching and listening closely for the senator’s words and actions.

If Nelson can’t make the case right now that rural Nebraska would be safe under the Reid legislation, then he should not vote to allow it to go forward.

Otherwise, congressional procedures would likely produce an ultimate result that — regardless of the senator’s possible “no” vote at the end — would deliver a terrible blow to Nebraska communities. That is the kind of result from which a state finds it hard to recover. The same can be said of a lawmaker’s reputation.

Earlier today, I attended a panel discussion at the Cato Institute about one of the most important aspects of health care that has gotten very little coverage during the current debate -- medical innovation.

Raymond Raad, a resident in psychiatry at New York Presbyterian Hospital/Weill Cornell Medical Center and co-author of a new Cato study, presented evidence showing that the United States leads the world in the development of drugs, medical devices, and other advanced treatments. For instance, between 1969 and 2008, 57 of the 97 Nobel Prizes in medicine and physiology -- or nearly 60 percent -- were awarded to people who did their research in the U.S., and nine of the top 10 medical innovations between 1975 and 2000 were developed here. But these achievements aren't reflected in rankings of different health care systems that typically show the U.S. faring poorly and provide fodder to those pushing for government-run health care. This even though once these products are developed in the U.S., they become widely available and improve health care outcomes around the world.

Raad argued that one of the big dangers of health care legislation is that expanding the role of government and trying to impose price controls could change incentives to innovate. When the government is such a large consumer of health care, it has tremendous influence over whether some innovations succeed. As an example, Raad noted how government stunted the growth of specialty hospitals by not allowing Medicare money to spent at them. Specialty hospitals are smaller institutions formed by doctors to focus on one type of illness, such as heart disease. They can deliver better health outcomes and a more personalized experience for patients than giant factory hospitals that benefit from their tax-exempt non-profit status even as they rake in billions of dollars. Raad explained that some of the most common and important medical innovations --such as CT scans -- were quite controversial when first introduced, and thus putting more constraints on the market could prevent wider use of new products that may ultimately prove beneficial.

Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University Bloomberg School of Public Health, described himself as the liberal on the panel. He emphasized the importance of universal access to new medical innovations, and argued that it was "naive" to talk about where innovations originated, since they all tend to be developed on a multi-national basis in many stages. He also showed that the pace of medical innovation has slowed in recent years, in both the U.S. and Europe, and said that it's important to do something to change incentives that are currently in place. Currently, large drug companies spend just 12 percent to 15 percent of their outlays on researching and developing new drugs, and 30 percent on marketing them.

John Calfee of the American Enterprise Institute suggested several reasons to worry about in the current health care bills. He said they would increase the costs to both the public and private sector well beyond what Congressional Budget Office is projecting. And he warned that it would be difficult for government to resist the temptation to impose price controls on products that were very expensive relative to their marginal costs. For instance, once drugs are developed, the cost to manufacture each additional pill is small relative to the price charged for the drug. But imposing such controls would reduce profits and thus the incentives of drug companies.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here